Forward head positioning and internal shoulder rotation are increasingly observed maladies in our society. As is well known to orthopedists, chiropractors, physical therapists, and other health care practitioners, the human head in its normal position should sit in a direct fashion on the neck and shoulders, with the shoulders in a neutral position. In part, because of various increasing habits in our society, the head can gradually become displaced from a normal, healthy posture of sitting directly on the neck and shoulders, to that of being displaced forward of that normal position. The phrase “forward head posture” (or “FHP”) has been used to describe this situation. FHP, combined with its often accompanying excessive internal shoulder rotation (or EISR), has indeed become so widespread, that it may already constitute a health hazard having ramifications that are pediatric, geriatric, orthopedic, and possibly systemic in nature, since when left untreated, FHP/EISR can develop degenerative and disabling joint diseases affecting countless numbers of people.
There are many reasons why FHP/EISR is developing into a more pervasive problem. The increasing use of computer screens can cause the user to move and maintain the head and shoulders in FHP/EISR. Handheld devices such as smart phones and touch pads have become common place, causing the user to maintain prolonged head flexion and internal shoulder rotation. The problem is seen in children and young adults who, in many cases, spend extended periods of time with texting, video games, and watching television.
The damage resulting from FHP/EISR is tied to the cervical portion of the spine becoming chronically fixated and misaligned into flexion. Additionally, prolonged internal rotation of the shoulder joints can contribute to skeletal distortion and function. Collective distortion of posture in this manner can lead to excessive tightening and eventual shortening of many important muscles, such as the levator scapula, upper trapezius, sternocleidomastoid, pectoralis (major and minor), anterior deltoid, and latissimus dorsi, to name a few. When the origin and insertion of a muscle excessively proximate for prolonged periods of time, the fibers begin to permanently shorten. “Davis' law” describes soft tissues' tendency to shorten and contract unless subject to frequent stretching. Other muscles, on the other hand, tend to become under active and weaken, such as the rhomboids (major and minor), mid trapezius, and posterior deltoids. The result of this imbalance, also in part due to the occulo-pelvic reflex (NASM), causes the entire body to adjust its normal, healthy posture in order to adapt to the distortion.
Health issues arising from FHP/EISR are well known and recognized in the health field as being potentially serious in nature, as described above. Although efforts to correct these issues by treatment with orthopedic devices available on the market have enjoyed varying degrees of success, many of these devices require going to a physician's office or facility, finding the time and place for lying down supine on the device, or wearing an inconvenient and cumbersome apparatus. Further, most of these devices are designed to effect change to FHP (and in some cases, address the cervical lordotic curve), but fail to effectively address the accompanying EISR that often accompanies FHP.
Most cervical collars are designed to immobilize the neck and/or cause axial translation to decompress the cervical spine while causing cervical spine straightening. Use of cervical collars may produce mixed benefits. Ligament impairment cannot improve around a straightened cervical curve (due to this abnormal alignment), which will ultimately result in permanent arthritic changes to the cervical joints. Ligament and muscle/tendon rehabilitation requires improvement of joint alignment, as well as lengthening of the related shortened and over active muscles, over time. As with any corrective orthopedic device, an accompanying exercise program designed to strengthen concomitant weakened muscles is also desired and recommended.
Devices are available for providing assistance in correcting reduced or reversed cervical curvature, forward head position, and excessive internal shoulder rotation. These devices are designed to assist in cervical remodeling, correctively exercising, stretching, and repositioning the cervical spine and upper torso.